特制克氏针骨水泥假体治疗肱骨近端恶性肿瘤的临床效果观察

Observation of clinical effect of using tailored Kirschner-wire cement prothesis to treat proximal humerus malignant tumor

目的 观察并分析肱骨近端恶性肿瘤切除后使用特制的克氏针骨水泥假体进行肩关节重建的临床效果。方法回顾性分析本院2007年3月至2017年12月间使用特制的克氏针骨水泥假体进行肩关节重建的病例,共筛选出45例患者,肱骨病变均局限于近端(MalawarⅠ型),重建术前所有患者通过活检来确定病理组织学诊断,其中18例骨肉瘤,18例软骨肉瘤,6例肺癌骨转移,3例前列腺癌骨转移。术后1年内于术后1、3、6、12个月进行随访,术后1年以后每年随访至少1次,并于每次随访时记录术后肩关节功能、综合治疗情况、术后并发症、肿瘤复发情况等。术后功能依据肌肉骨骼肿瘤学会(MSTS1993)评分进行评估。结果 45例患者中男27例,女18例,均得到了完整随访,手术时患者平均年龄为(40.07±19.88)岁(18~76岁),瘤段切除均长(11.37±1.45)cm(9~12.5 cm),术后平均随访时间(39.21±18.73)个月(14~83个月)。截至末次随访,2例患者术后早期出现了桡神经的支配区域的皮肤麻木情况,经对症治疗都在4个月后麻木情况消失;3例患者因肿瘤复发行肩关节离断术,3例患者出现克氏针断裂行翻修术,其余患者未出现骨水泥松动及骨折,其余患者的肘、腕、掌关节功能得到了完全保留。除去3例因局部复发行肩关节离断的病例,共随访得到了42例患者的肩关节MSTS评分,截止末次随访时平均MSTS评分为(76.5±7.99)%(66%~90%)。结论 特制的骨水泥肱骨头假体用于肱骨近端骨恶性肿瘤切除术后重建肩关节,在达到保肢目的的同时可以有效地保留肘、腕、掌关节的功能,能够维持肩关节的稳定性,术后早期临床效果良好。

Objective To observe and analyze the early stage clinical effect of using tailored Kirschner-wire cement prothesis to reconstruct shoulder joint after resection of malignant proximal humerus tumor.Methods During March 2007 to December 2017,the patients using tailored Kirschner-wire cement prothesis to reconstruct shoulder joint after resection of malignant proximal humerus tumor were analyzed in our hospital.In total,45 patients were included,with lesions all be confined to the proximal humerus(Malawar typeⅠ).Preoperative biopsy was done to determine pathological histology diagnosis.Among them,18 cases were osteosarcoma;18 cases were chondrosarcoma;6 cases were bone metastases of lung cancer;3 cases were bone metastasis of prostate cancer.Follow-up was conducted at 1,3,6 and12 months after the operation within one year,and at least once a year later.Postoperative shoulder joint function,comprehensive treatment,postoperative complications and tumor recurrence were recorded at each follow-up.Postoperative function was assessed according to the musculoskeletal oncology society(MSTS1993)score.Results Among the 45 patients,there were 27 males and 18 females,and all the 45 patiens were fully followed up.The mean age of patients at the time of surgery was(40.07±19.88)years,aged from 18 to 76 years old.The mean length of tumor resected was(11.37±1.45)cm(9-12.5 cm).The mean time of follow up was(39.21±18.73)month(14-83 months).Until last follow-up,2 patients had early postoperative skin numbness in the innervated area of the radial nerve,and the numbness disappeared after 4 months of symptomatic treatment;there were 3 patients suffering fourth-quarter amputation due to local recurrence;there were 3 patients having Kirschner-wire broken thus took revision;the rest of the patients did not appear loose and fracture of bone cement;all the rest patient’s elbow joint,wrist joint and metacarpus joint got completely retained.Besides the 3 patients suffering fourth-quarter amputation due to local recurrence,the mean MSTS score of the 42 patients at the last follow-up was(76.5±7.99)%(66%-90%).Conclusion Tailored Kirschner-wire cement humeral head prothesis used for reconstruction of shoulder joint after resection of proximal humeral bone malignant tumor can retain the function of shoulder,elbow,wrist and metacarpal joint,and effectively maintain the stability of shoulder joint,having a good clinical effect at early stage follow up.